Chapter 4

This chapter examines different depressive disorders, focusing on major depressive disorder (MDD) and dysthymia, along with less common disorders like premenstrual dysphoric disorder (PMDD) and disruptive mood dysregulation disorder (DMDD). **DISRUPTIVE MOOD DYSREGULATION DISORDER (DMDD)** (296.99) is a new DSM-V diagnosis characterized by a persistently angry or irritable mood in children aged 6-18, accompanied by frequent aggressive outbursts. Symptoms must occur at least three times weekly and be present for 12 months. DMDD affects less than 1% of the general population and is often comorbid with other disorders such as ADHD and anxiety. Treatment includes family-centered therapy and potentially medication to facilitate therapy, as affected children have a high risk of self-harm and suicidal behaviors. **MAJOR DEPRESSIVE DISORDER (MDD)** (296.20-296.36) involves a pervasive low mood and loss of interest in activities. Diagnosis requires symptoms lasting at least two weeks, including depressed mood, weight changes, fatigue, and suicidal thoughts. Patients must experience five of eight specific symptoms. Treatments typically involve antidepressants and psychotherapy, with exercise proving effective for mild to moderate cases. **DYSTHYMIA (Persistent Depressive Disorder)** (300.4) is chronic depression lasting most days for at least two years, often presenting less severe than MDD. To diagnose PDD, two criteria related to low self-esteem or fatigue must persist, with symptoms not abating for longer than two months and no episodes of hypomania or mania. Treatment involves psychotherapy or medication, generally requiring long-term care. **PREMENSTRUAL DYSPHORIC DISORDER (PMDD)** (625.4) is recognized in the DSM-V with symptoms occurring before menstruation and resolving shortly after. At least five symptoms, including mood lability and physical pain, must be present across menstrual cycles to meet criteria. Treatments may include SSRIs, hormonal treatments, and cognitive behavioral therapy. **SUBSTANCE OR MEDICATION-INDUCED DEPRESSIVE DISORDER** includes mood symptoms triggered by various substances, where symptoms can arise even in prescribed doses. Diagnosis requires consultation with specialists, and ongoing psychotherapy is often necessary as a means of management. **DEPRESSIVE DISORDER DUE TO A MEDICAL CONDITION (293.83)** includes conditions like hypothyroidism or neurological issues that can result in depressive symptoms. Treatments may involve psychological interventions, and recovery can vary based on the medical condition causing the depression.